HomeMy Public PortalAbout8754 HERMOSA DR_Sewer__ CEBOB D10-63
76A64 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �-.
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup'1 of Building
LOCALITY Q
NEAREST
FOR APPLICANT TO FIL IN CROSS IT,
LEGAL �(�yy��'
DESCRIPTION LOT NO, _ _/ l C r� OWNER
J = MAIL
BLOCK TRACT ADDRESS
NO. OF BLDG..
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS
/ BK
CONTRACTORAt
ADDRESS J� ION CONNECTION DATA
4 Y
CITY TEL. NO.gG�'XI IS_ O , DEPTH
STATE MA NHOLE REFERENCE UPPER
REGISTRATION NO. ��JJ(q( ❑ CODNTV
NO. DESCRIPTION OF WO FEEYPE OF N ION LENGTH F OM
HOUSE SEWER CONNECTING TO i `D Y. �j!!C. M.L.TOP C
PUBLIC SEWER °e 55.00 V O
SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO, /�� O JOB NO.
PITS AND/OR DRAINFIELD ® SIO,.o
HOUSES W CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, \�
PRIVATE DISPOSAL SYSTEM to 53.00 - /1
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT nIY [n5[m[xi RECORD.INSTR.NO. DATE Vr
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT.DRAINFIELD
YI W
EXTN.,CE55POOL,DRWEL L.MANHOLE C $5.00
ALTER, REPAIR OR ABANDON HOUSE HWY.OR ST,WIDENING y
SEWER OR DISPOSAL SYSTEM $3,00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WA57E APPROVAL
CHARGES
OWNERS PERMIT $ z 00
AUTHORIZATION I TOTAL FEE6� CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS —DAY OF 19_
OWNER OR A" / NEW HOUSE SEWER L/ r .i A
OWNERS AGENT CONNECT ADDITIONAL / v
BUILDING OR WORK
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP.PIT(B)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I M THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABO SCRIBED RESIDENTIAL PROPERTY.
ABANDON HOOSE SEWER
SIGNATURE
OF PERMITTEE_ - Or Bt"ACKPI LSEPTIC CESS ❑
A 11w SEEP,PIT I51 ❑ CESSPOOLS ❑
ION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
LAAO 0 9 7 5 w APR 4 1 0 A 7.00-
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A642D -63 + APPLICATION FOR PERMIT
E808 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION [NEA:R.
UILDING 5.+ .�
IOHN A. LAMBIE, County Engineer DDRESS !
WILLIAM A. ]ENSEN, Sup'1 0l Building
OCALITY
E3TFOR APPLICANT TO FILL IN GRo5T.
LEGAL
A —
DESCRIPTION LOT NO. fKf= OWNER TO^�'�
MAILlog
BLOCK TRACT ADDRESS
N. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GR MAP PROCESSED BY
BK 6J �a/i
CONTRACTOR ( �'
ADD EBB `/ CONNECTION DATA
CITY TEL. NO. �- ON L DEPTH
B ATE UPPER
MANHOLE REFERENCE
REGISTRATION NO. _ COUNTY
NO, DESCRIPTION OF WO K FEE YPEOO E I(1N LENGTH OM
HOUSE SEWER CONNECTING TO M.L.TO .L. -�i{.� Y
PUBLIC SEWER IS $5.00 P,C.NO. a
SEPTIC TANK,SEEPAGE PIT OR O JOB NO. O
PITS AND/OR GRAINFIELD 510.00 rTRU.K
. NO. O
HOUSE SEWER CONNECTING TO rPERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM S3.00 lJ
CONNECT ADDITIONAL BLDG,OR AFFIDAVIT uvq [AS[x[xi RECORO.INSTR.NO. DATE O
WORKTO HOUSE SEWER 53.00 v
OVERFLOW SEEPAGE PIT,GRAINFIELD W
EXTN„CESSPOOL.DRYWELL.MANHOLE@ 55.00 y
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING y
SEWER OR DI5POS L STCM ® $3,00 STATE ENCROACHMENT
n 0-V PERMIT NO,
C/ ,Iv/ INDUSTRIAL
WASTE APPROVAL
OWNERCHARGESS PERMIT S
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBU RSEM ENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PGOLD SEWER, APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS DAYOF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
4GORE55
SEPTIC TANK,BEER.IELD T15)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION LY gry0/Ofl DRgINFIEID
ANO STATE THAT THE ABOVE I5 CORRECT AND AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL ElPLV
PLUMBING AND SEWERS.
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM ith
CALIFORNIA OR THAT AM THE LEGAL OWNER OF, AND INTEND TO D15CONNECT PLUG AND
RESIDE IN, THE AB E ESCRIB D RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE ((Y21Q SEEP,PITI51 ❑ CESSPOOLS ❑
OVALIDATION ROBERT WOOD
CASH SUPERVISING MECHANICAL ENGINEER
LA—bo
0 9 7 6�8 APR 4 1 1 A 2 5.0 O~ c